Ligating clip with flanged base having a recessed engaging face

ABSTRACT

A ligating clip is provided with first and second legs joined at their proximal ends by a resilient hinge to define the rear end of the clip and spaced at their distal ends at the front of the clip with the legs having latch means at the distal ends for holding the clip closed in clamping engagement about tissue when the legs are squeezed together. The clip has a base extending along a portion of the first leg and the base terminates short of the distal end in a front face. Flanges are provided on a portion of the base and extend rearwardly from the front face and terminate short of the first leg proximal end. The flanges extend laterally outwardly beyond the sides of the first leg. The portion of the base that extends rearwardly from the flanges to the proximal end of the clip first leg has a width not greater than the width of the first leg.

TECHNICAL FIELD

This invention relates to hemostatic or ligating clips adapted to beapplied with surgical instruments to tissue, blood vessels, and thelike.

BACKGROUND OF THE INVENTION

Clips have been devised for clamping or strangulating various organs,vessels, and other tissue. Clips have been developed for usespecifically in strangulating blood vessels in the human body. Suchclips are known as hemostatic or ligating clips. The clips may befabricated from absorbable or nonabsorbable polymeric materials as wellas from metal.

A ligating clip is typically C-shaped, U-shaped, or V-shaped with twospaced-apart or diverging legs connected together at one end in a mannerthat permits the clip to be squeezed together so that the legs of theclip may be clamped around the tissue or blood vessel so as to tightlyconstrict the tissue or blood vessel. This prevents a substantial amountof fluid from passing through the tissue or blood vessel from one sideof the closed clip to the other side of the closed clip.

Typically, the clip is made of a material and/or has a configurationthat enables the clip, once it has been forced closed, to maintain theclosed orientation without outside intervention. For example, if theclip is made from a metal material, the clip can be deformed to theclosed position. If the clip is made from a thermoplastic material, thelegs may be connected by a resilient hinge portion and the distal endsof the legs may be provided with latch means for holding the legstogether in a closed position when the legs of the clip are squeezedtogether around the tissue or blood vessel.

Various novel ligating clips are disclosed in copending U.S. patentapplications assigned to the assignee of the present invention: Ser.Nos. 208,368, filed on Nov. 19, 1980; 276,131, filed on June 22, 1981;277,582, filed on June 26, 1981; 277,454, filed on June 26, 1981;282,461, filed on July 13, 1981; and 296,672, filed on Aug. 27, 1981.

Some types of surgical clips have been proposed wherein one of the legsof the clip is especially adapted for being engaged by, and supportingthe clip in, an applier instrument. See, for example, U.S. Pat. Nos.3,780,416 and 3,882,854 which each disclose an asymmetric clip havingtwo differently shaped legs with one of the legs being adapted to bereceived in a carrier or lower jaw of an applier instrument.

It would be desirable to provide a ligating clip which could be easilyapplied by an instrument to tissue, such as a blood vessel and the like.Further, it would be desirable to provide such a clip with aconfiguration that would permit a plurality of such clips to be loadedinto, and contained within, the instrument for applying the clips.

Further, it would be beneficial if the clip could be provided with aconfiguration that would permit the clip to be easily accommodated inthe instrument and to be moved forward within the instrument to the clipapplying jaws of the instrument by a relatively simple and trouble freemechanism.

Also, it would be advantageous if such a clip had a configuration whichwould permit it to be restrained within the clip applying instrument andto be guided by the clip applying instrument to the jaws of theinstrument.

A variety of instruments for applying certain types of surgical clipshave been developed or proposed in the past. A number of suchinstruments are discussed and disclosed in the copending patentapplication Ser. No. 208,368, filed on Nov. 19, 1980. Such instrumentstypically include a magazine or cartridge which may or may not bedisposable and which holds a plurality of clips. The clips are suppliedfrom the cartridge to jaws of the instrument one at a time forapplication to the tissue or blood vessel.

U.S. Pat. No. 3,006,344 discloses an instrument for applying a ligatingclip to a blood vessel. The clip is formed of flat metal or like stockand has a pair of legs extending outwardly in a generally V-shape. Theclips are arranged in two parallel grooves in a magazine. A slide ispositioned in each groove and is urged by a suitable conventional springto advance the clips along the magazine toward the jaws. The clips arearranged in each row with the distal end of one of the legs of one clipabutting the rear connecting hinge portion of the next adjacent clip.

U.S. Pat. No. 3,753,438 discloses an applicator for applying clips tosuturing thread during the suturing of skin wounds. The clips arecarried in a cartridge in the instrument. A clip is forced forwardlyfrom the cartridge to a position between the instrument jaws by a slidewhich is operated by a handle. After the clip is positioned within thejaws, the handles of the instrument are squeezed together to squeeze theclip legs together.

SUMMARY OF THE INVENTION

A novel ligating clip is provided that is particularly well-suited foruse with a scissors-type medical instrument is provided for repeatedlyapplying a plurality of the ligating clips seriatim about tissue.

A preferred embodiment of the clip of the present invention isfabricated from a thermoplastic material. The clip typically has twolegs that are connected together at one end of the clip and that areadapted to assume an initial open or spread apart configuration at theother end.

The clip includes first and second legs joined at their proximal ends bya resilient hinge to define the rear end of the clip and spaced apart attheir distal ends at the front of the clip with the legs having latchmeans at the distal ends for holding the clip closed in clampingengagement about tissue when the legs are squeezed together.

In a preferred embodiment, the clip has a base extending along a portionof said first leg. The base terminates short of the distal end of thefirst leg in a front face whereby an open recess is defined adjacent thefront face of the base below the first leg. With one type of applierinstrument, this permits positioning of an escapement mechanism of theinstrument against the face.

Flanges are provided on a portion of the base. The flanges extendrearwardly from the front face and terminate short of the first legproximal end. The flanges extend laterally outwardly beyond the sides ofthe first leg. With one type of applier instrument, the flanges functionas guide means for engaging portions of the instrument.

The portion of the base that extends rearwardly from the flanges to theproximal end of PG,6 the clip first leg has a width not greater than thewidth of the first leg. With one type of applier instrument, such a basestructure facilitates ejection of the latched closed clip from theinstrument when the escapement is withdrawn.

The first leg of the clip may be alternatively described as having (1) arear section extending from the hinge, (2) a front section extendingfrom the distal end of the first leg, and (3) a middle sectionconnecting the front and rear sections. The base can then be regarded asextending along the rear and middle sections of the first leg andterminating in a front face below the juncture of the middle and frontsections of the first leg so that the first leg front section extendsforwardly beyond the base front face to define an open recess adjacentthe base front face below the first leg front section. The portion ofthe base along the first leg rear section has a width not greater thanthe width of the first leg. The base flanges extend laterally outwardlybeyond the sides of the first leg along the length of the clip first legmiddle section.

Numerous other advantages and features of the present invention willbecome readily apparent from the following detailed description of theinvention and an embodiment thereof, from the claims, and from theaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

In the accompanying drawings forming part of the specification, and inwhich like numerals are employed to designate like parts throughout thesame,

FIG. 1, on the sheet of drawings with FIGS. 13A and 13B, is a greatlyenlarged, perspective view of an open ligating clip of the presentinvention;

FIG. 2A is a side view of the preferred embodiment of the medicalinstrument that can be used for repeatedly applying a plurality ofligating clips of the type illustrated in FIG. 1;

FIG. 2B is a cross-sectional view taken generally along the planes2B--2B in FIG. 2A and showing the instrument jaws open;

FIG. 2C is a greatly enlarged, fragmentary, cross-sectional view similarto FIG. 2B but showing the instrument latching a clip closed;

FIG. 3 is a greatly enlarged, cross-sectional view taken generally alongthe planes 3--3 in FIG. 2B;

FIG. 4 is a greatly enlarged, cross-sectional view taken generally alongthe plane 4--4 in FIG. 2B;

FIG. 5 is a greatly enlarged, cross-sectional view taken generally alongthe plane 5--5 in FIG. 2B;

FIG. 6 is a greatly enlarged, fragmentary, cross-sectional view takengenerally along the plane 6--6 in FIG. 2B;

FIGS. 7-12 are greatly enlarged, fragmentary, cross-sectional views ofthe front jaw region of the instrument showing the sequence of operationof the instrument;

FIG. 13A is an exploded, perspective view of the instrument; and

FIG. 13B is a greatly enlarged, fragmentary, perspective view of one ofthe two mating pieces that form the lower jaw in the region indicated bythe dashed line circle labeled 13B in FIG. 13A.

DESCRIPTION OF THE PREFERRED EMBODIMENT

While this invention is susceptible of embodiment in many differentforms, there is shown in the drawings and will herein be described indetail a preferred embodiment of the invention. It should be understood,however, that the present disclosure is to be considered as anexemplification of the principles of the invention and is not intendedto limit the invention to the embodiment illustrated.

The precise shapes and sizes of the structural parts of the novel clipand clip applier instrument herein described are not essential to theinvention unless otherwise indicated. Unless otherwise indicated, theparticular shapes and sizes are shown to best illustrate the principlesof the invention.

A preferred embodiment of the ligating clip 10 of the present inventionis illustrated in FIG. 1. The clip 10 has a first leg 11 and a secondleg 12. The legs 11 and 12 are joined at their proximal ends at the rearof the clip by a resilient hinge, hinge means, or hinge section 13 whichpermits the legs 11 and 12 to be pivoted toward each other to a closedposition. Until the clip 10 is closed in a manner to be described indetail hereinafter, the hinge 13 has sufficient resiliency to maintainthe legs 11 and 12 in the angled open position illustrated in FIG. 1.

The first leg 11 terminates at the distal end thereof in a hook member14 having a downwardly facing inner face 15 substantially parallel to anupwardly facing inner face 16 of the first leg 11 and forming an acuteangle with an end face 17.

The second leg 12 terminates at the distal end thereof in an end face 19which forms an obtuse angle with an inner face 18 of the leg 12. The endface 19 of the second leg 12 is formed at an angle relative to a squaredoff face 25 which forms a substantially right angle with an uppersurface 20.

The length and width of the face 16 of the first leg 11 and of the face18 of the second leg 12 are substantially equal, and the face 15 of thehook member 14 is spaced from face 16 of the leg 11 by a distancecorresponding to the thickness of the leg 12 between the plane of innerface 18 and the plane of upper surface 20.

When the legs 11 and 12 are pivoted about hinge 13 to bring the faces 18and 16 into opposition, the hook member 14 is deflected by the end face19 of the second leg 12 until the distal end of the second leg 12 snapsunder the hook member 14 and is thereby locked in place. Such a closureof the clip 10 is illustrated in FIG. 9 wherein the clip 10 is shownlatched or locked closed about a blood vessel 200.

The end face 17 of the hook member 14 and the end face 19 of the secondleg 12 are angled as illustrated to facilitate the passage of the secondleg 12 past the hook member 14 during closure of the clip 10.

When the clip 10 is closed over a blood vessel 200 (as illustrated inFIG. 9), the surfaces 16 and 18 engage and compress the vessel 200 toclose the lumen thereof. The surfaces 16 and 18 may be smooth asillustrated in FIG. 1, or may be provided with ridges or grooves toincrease vessel holding power.

The first leg 11 may also be undercut at the juncture of the hook member14 and the surface 16 as illustrated in FIG. 1 to increasedeflectability of the hook member 14 and increase the space between thehook member 14 and the leg 11, thereby compensating for any inwarddeflection of the hook member 14 during closure of the clip which mightreduce the clearance between the hook member surface 15 and the firstleg surface 16 and otherwise interfere with the latching of the clip 10.

The clip 10 may also include an outside cylindrical boss 21 extendingacross the width of the second leg 12 near the distal end thereof. Theboss 21 is spaced from surface 25 a distance sufficient to permit fullengagement of the hook member 14 by the leg 12 when the clip 10 is in aclosed and latched position.

The clip 10 also has a novel base 45 extending along a portion of thefirst leg 11. The base 45 terminates short of the distal end of thefirst leg 11 in a front face 50 whereby an open recess is definedadjacent the front face 50 and below the first leg 11 to permitpositioning of an escapement mechanism of the instrument against theface 50. Such an escapement mechanism is described in detailhereinafter.

Flanges 52 are provided on a portion of the base 45. The flanges 52extend rearwardly from the front face 50 and terminate short of thefirst leg proximal end. The flanges 52 extend laterally outwardly beyondthe sides of the first leg 11 to function as guide means for engagingportions of the instrument. The portion of the base 45 that extendsrearwardly from the flanges 52 to the proximal end of the clip first leg11 has a width not greater than the width of the first leg 11 tofacilitate ejection of the latched closed clip from the instrument whenthe escapement is withdrawn.

Depending on the type of instrument used to apply the clip 10 to tissue,the hook member 14 may be provided on the second leg 12 instead of onthe first leg 11 with the base 45. Further, other suitable latchingstructures (not illustrated) may be provided at the ends of the cliplegs. The illustrated hook member 14 on leg 11 and the cooperating endof the other leg 12 are just one example of a suitable latching meansstructure.

The first leg 11 of the clip 10 may be alternatively described as havingthree sections: a rear section 41, a middle section 42, and a frontsection 43 as best illustrated in FIG. 1. The rear and front sections 41and 43, respectively, are connected by the middle section 42.

In terms of the above-identified three leg sections, the base 45 can beregarded as extending along the first leg 11 and terminating in thefront face 50 below the juncture of the leg middle section 42 and theleg front section 43. Thus, the first leg front section 43 extendsforwardly beyond the base front face 50 to define an open recessadjacent the base front face 50 and below the first leg front section43.

The clip flanges 52 can be regarded as extending along the length of theclip first leg middle section 42 and as extending laterally outwardlybeyond the sides of the first leg 11.

The portion of the base 45 along the first leg rear section 41 extendsrearwardly from the flanges 52 but has a width that is not greater thanthe width of the first leg 11. The portion of the base 45 along thefirst leg rear section 41 has a generally right rectangular prismconfiguration. Similarly, the portion of the base 45 with the flanges 52along the first leg middle section 42 has a generally right rectangularprism configuration.

Portions of the clip first leg 11 and of the base 45 are adapted tofunction as guide means for engaging portions of the instrument and forbeing engaged by the escapement mechanism of the instrument. A preferredembodiment of such an instrument is next described in detail.

Each of the above-described novel clip structures, when fabricated froma suitable thermoplastic material, is biased to the open position by theresilient hinge portion. Thus, if force is applied to the distal ends ofthe legs of the open clip so as to move the legs toward one another (butnot far enough to latch the clip), then upon removal of the force fromthe clip legs, the clip legs will return to the substantially fully openorientation.

It is believed that this phenomenon can be used to advantage in certaintypes of clip applier instruments for guiding and holding the clip inthe instrument. Specifically, the legs of the clip may be deflectedinwardly toward one another a small amount in a magazine, guide channel,or jaw structure of a clip applier instrument. Owing to the resilienceof the hinge joining the two legs, the two legs will exert a forceoutwardly against the magazine, channel, or jaw structure to therebyprovide a small friction holding force which may serve to help maintainthe clip in the proper orientation or position within the instrument.

The above-described action of the resilient hinge plastic clip is incontrast with conventional ligating clips fabricated from relativelysmall diameter wire-like stock. Such metal clips can toleratesubstantially no inward deflection of the legs without undergoingpermanent deformation. Consequently, such metal clips exhibit no usefuldegree of resiliency and thus do not have the same inherent capabilityfor providing the frictional holding force that is found in theabove-described type of plastic clip. Of course, if the clip is to beapplied with a type of instrument that does not make use of theresilient hinge capability of the clip, then the clip may be fabricatedfrom any suitable material with the novel base structure, but without aresilient hinge.

A scissors-type medical instrument 100, generally illustrated in FIGS.2A and 2B, is adapted for holding a supply of the above-describedligating clips 10 of the present invention and for applying the clipsseriatim to tissue.

The instrument 100 has a first handle 101 and a second handle 102. Thefirst handle 101 has a finger or thumb ring 104 and the second handlealso has a finger or thumb ring 106. As best illustrated in FIG. 13A,the first handle 101 includes two mating pieces or halves 101A and 101Bwhich are secured together by suitable means, such as by screws (notillustrated).

The first and second handles 101 and 102 are mounted together forpivotal movement about a pivot axis defined by two spaced-apart coaxialshafts 108. Each shaft 108 has an exterior head or cover 110 which isreceived in a cavity 111 in each side of handle 102 (FIGS. 4 and 13A).The distal end of each shaft 108 is press-fitted into an aperture 109 inthe side of the handle half 101A or 101B (FIGS. 4 and 13A).

Each handle 101 and 102 extends forwardly beyond the pivot axis shafts108 to form a clip-closing jaw--a first handle lower jaw 111 and asecond handle upper jaw 112 as illustrated best in FIGS. 2B and 13A. Ascan best be seen in FIG. 2A, the jaws 111 and 112 are preferably curvedtoward one side.

As best illustrated in FIGS. 2B, 5 and 13A, the second handle 102 has apair of spaced-apart sidewalls 114 and 116 projecting upwardly from abottom wall 118 to define a generally U-shaped configuration. Toward thefront of the instrument 100, in the region below the pivot shafts 108,the second handle bottom wall 118 terminates but the sidewalls 114 and116 continue upwardly. As best illustrated in FIG. 13A, the sidewalls114 and 116 project upwardly above the pivot shafts 108 and merge toform the second handle upper jaw 112.

The first handle halves 101A and 101B define a chamber, channel, orguideway 120 as best illustrated in FIGS. 4, 5, and 13A. The guideway120 receives a plurality of the open clips 10 in end-to-end relationshipwith the distal end of the first leg of one clip abutting the hinge endof the next forwardly adjacent clip. The clips can be moved forwardlyalong the guideway 120 by means described hereinafter in detail.

As best illustrated in FIGS. 3 and 13A, the first handle 101 defines abottom channel 122 for receiving the clip base and base flanges 52 ofeach clip 10. The instrument 100 includes inwardly projecting flanges124 above the bottom channel 122. The flanges 124 of the guideway 120function to engage the base flanges 52 of the clips when the instrument100 is tilted or turned to any position other than the horizontalposition illustrated in FIG. 2B. The flanges 124 thus function to retainthe clips within the instrument 100. The channel 122, in cooperationwith the flanges 124, permits sliding movement of the clips 10 forwardlyalong the guideway 120.

The clips 10 are moved forwardly along the guideway 120 to the region ofthe jaws 111 and 112 by a novel pusher member 128. The pusher member 128is preferably a flexible, perforated tape defining a plurality ofequally spaced apertures 130 extending along the length of the tape.Preferably, each aperture 130 has a substantially rectangularconfiguration.

The flexible pusher member tape 128 preferably has a generallyrectangular cross-section and is adapted to be received within thechannel 122 behind the last clip of the row of clips 10 in theinstrument first handle 101. Preferably a trailing portion of the tape128 extends around an approximately semi-circular portion of theperiphery of a chamber 132 (FIG. 13A) in the rear portion of the firsthandle 101 and is received within an upper tape slot 134 located above,and substantially parallel to, the channel 122.

The instrument 100 further preferably includes a means for feeding thetape 128 forwardly along the channel 122 at the bottom of the guideway120 to move the row of clips 10 forwardly along the first handle 101 tothe jaws 111 and 112. Specifically, a sprocket wheel 136 is mounted forrotation within the chamber 132 relative to the first handle 101. Thesprocket wheel 136 has a plurality of circumferentially spaced andradially outwardly projecting pins 138 which are adapted to engage theperforations or apertures 130 in the tape 128.

As best illustrated in FIGS. 6 and 13A, the sprocket wheel 136 includesa hub 140 for rotating with the wheel 136 relative to the first handle101. A flexible cord 142 is wrapped or wound around the hub 140 and issecured to one end of a tension spring 144 disposed within the firsthandle 101. The other end of the tension spring 144 is secured at a postor pin 148 (FIGS. 2B and 13A) to the first handle 101. The spring 144thus pulls the cord 142 from the hub 140 to thereby rotate the hub 140and the wheel 136 to drive the tape 128 forwardly in the clip guidewaybottom channel 122.

In FIG. 2B, the spring 144 is shown in dashed line in the initialposition when the instrument 100 is fully loaded with clips 10 and whenthe spring 144 is at a maximum elongation. When the instrument 100 isfully loaded, the clips 10 fill up almost the entire length of theguideway 120 along the first handle 101 and only a short leading endportion of the flexible tape 128 projects into the guideway bottomchannel 122 behind the last clip. Thus, a trailing portion of the tape128 may initially project out of the upper tape slot 134 and may becoiled within the first handle 101. As the clips are applied by theinstrument (in a manner to be described hereinafter), the spring 144continuously urges the sprocket wheel 136 to rotate and advance the tape128 forward along the bottom channel 122 of the first handle 101. Asthis occurs, the spring 144 gradually relaxes and the length of thespring 144 approaches a minimum extension length which is illustrated insolid line in FIG. 2B.

A novel mechanism is provided for 1) preventing the clips 10 from beingpushed out of the end of the jaws 111 and 112 until after the jaws areactuated and 2) ensuring that only one clip at a time is properlylatched closed about a blood vessel and discharged from the instrument100. As best illustrated in FIGS. 2C, 3 and 13A, an escapement member160 is mounted for pivotal, rocking movement about a cylindrical shaft162 within the first handle lower jaw 111 below the clip guidewaychannel 122. The shaft 162 is disposed in the jaw 111 with itslongitudinal axis generally parallel to the longitudinal axis of theshafts 108 about which the handles 101 and 102 pivot.

As best illustrated in FIGS. 13A and 13B, each half 101A and 101B of thefirst handle 101 defines an aperture 163 for receiving an end of thepivot shaft 162. The rocker member 160 is adapted to be pivoted orrocked in the first handle lower jaw 111 between a first orientationillustrated in FIG. 2B and a second orientation illustrated in FIG. 2C.

The escapement member 160 has a forward protuberance 164 adapted toproject in front of the guideway channel 122 to engage the front face 50of a base of a clip 10 to prevent passage of the engaged clip therepastwhen the escapement member 160 is in the first orientation (FIG. 2B).The escapement member 160 also has the rearward protuberance 166 as bestillustrated in FIGS. 2C and 13A. The rearward protuberance 166 is spacedrearwardly of the forward protuberance 164 by an amount greater than thelength of the base of a clip 10 (i.e., greater than the length of thefirst leg rear section 41 and the first leg middle section 42 asillustrated in FIG. 1). The rearward protuberance 166 is adapted toproject into the guideway lower channel 122 to engage the front face 50of a base of the next rearwardly adjacent clip 10 to prevent the passageof that clip therepast when the escapement member 160 is in the secondorientation (FIG. 2C).

As best illustrated in FIGS. 2C and 13A, a rod 168 is hingedly connectedto the bottom of the escapement member 160 and extends rearwardly fromthe escapement member 160 along the first handle 101. In the illustratedpreferred embodiment, the escapement member 160 and the rod 168 areintegrally molded from a suitable thermoplastic polymer material as aunitary assembly including a flexible or living hinge designatedgenerally by reference numeral 170 in FIGS. 2C and 13A. Of course, it isto be realized that the escapement member 160 and rod 168 need not befabricated as a unitary piece and may be connected together by anysuitable hinge or pivot structure.

The rod 168 has a distal end portion 172 which is generally cylindricaland is threaded at 173. A flange 174 is provided inwardly of the threads173 at the inner end of the cylindrical portion 172 of the rod 168. Aspring 176 is disposed on the rod cylindrical portion 172 and isreceived in a cavity 178 for biasing the rod 168 forwardly to pivot theescapement member 160 about the pivot shaft 162 into the firstorientation to prevent the passage of a clip from the instrument jaws.

A cylindrical cam follower 180 is threadingly engaged with the threads173 at the distal end of the cylindrical portion 172 of rod 168 andprojects laterally at an angle, preferably 90 degrees, relative to thelongitudinal axis of the rod 168. The ends of the cylindrical camfollower 180 are disposed within an elongate cavity 182 within the firsthandle 101. The elongate cavity 182 is open at either end to permit thedistal ends of the cylindrical cam follower 180 to project outwardlybeyond the sides of the first handle 101 as best illustrated in FIG. 5.

As best illustrated in FIGS. 2C, 5, and 13A, the second handle 102defines a cam or cam surface 184 for engaging and moving the camfollower 180. Specifically, the second handle sidewalls 116 and 114define a stepped cam surface 184 that has a configuration to urge thecam follower 180, and hence the rod 168, rearwardly when the handles 101and 102 are moved toward one another a sufficient amount so as tosqueeze together and latch closed the front clip in the row asillustrated in FIG. 2C. This causes the escapement member 160 to bepivoted to the second orientation wherein the forward protuberance 164is retracted below the guideway channel 122 to permit the discharge ofthe clip.

The handles 101 and 102 are normally urged apart to an open positionillustrated in FIG. 2B by a helical compression spring 190 disposedbetween the first handle finger ring 104 and the second handle fingerring 106. When the handles 101 and 102 are squeezed together, overcomingthe biasing effect of the spring 190, the closure movement is limited byan abutment member 192 on the second handle finger ring 106 whichengages the first handle finger ring 104.

On the other hand, the handles 101 and 102 cannot be opened any furtherthan shown in FIG. 2B. This is because an abutment face 196 (FIG. 2C)behind the upper jaw 112 of the second handle 102 engages an abutment198 on the first handle 101 above the pivot shafts 108.

The handles 101 and 102 may be biased to the open position illustratedin FIG. 2B by means other than the helical compression spring 190. Forexample, a leaf-type spring 199 may be disposed within the second handle102 as illustrated in dashed lines in FIG. 2B. Such a leaf-type spring199 would be contained between the sidewalls 114 and 116 of the secondhandle 102 and would have a portion bearing against the first handle 101to bias the first and second handles apart.

The sequence of operation of the instrument 100 will next be describedin detail with reference to FIGS. 2B, 2C and 7-12. When the instrument100 is in the fully opened position illustrated in FIG. 2B, theescapement member 160 is in the first orientation to engage the frontface 50 of the front clip 10 in the row of clips. The same orientationis shown in the enlarged view in FIG. 7 wherein the front clip 10 isshown disposed within the jaws 111 and 112 in an open position adjacenta blood vessel 200.

When the jaws are initially fully opened as illustrated in FIGS. 2B and7, the front clip 10 is fully opened, but the upper leg of the clip isnot in contact with the upper jaw 112. However, the clip base flanges 52are of course disposed within the guideway lower channel 122 so that theclip is retained in the jaw region by the flanges 124 (FIG. 3). Also,when the open front clip 10 is in the position illustrated in FIG. 7,the clip base front face 50 is engaged by the forward protuberance 164of the escapement member 160 and further forward movement of the clip isthus prevented. Although the rearward protuberance 166 of the escapementmember is retracted out of the guideway below the next rearwardlyadjacent clip, the front end of that next rearwardly adjacent clip abutsthe hinge portion of the front clip. All of the remaining clips aresimilarly disposed in end-to-end engagement back to the last clip whichis urged forwardly by the flexible tape 128 (FIG. 2B).

FIG. 8 illustrates the jaw region of the instrument as the jaws 111 and112 begin to close against the front clip 10. The jaws 111 and 112 aremoved together by pivoting the instrument handles 101 and 102 (FIG. 2B)toward one another. When the handles 101 and 102 are moved toward oneanother a sufficient amount, the cam surfaces 184 (FIGS. 2B, 2C, and13A) urge the cylindrical cam follower 180 rearwardly in the cavity 182.This pulls the rod 168 rearwardly in the direction of the arrow 204 asbest illustrated in FIGS. 2C and 8. The rearward movement of the rod 168causes the escapement member 160 to pivot (in the clockwise direction asviewed in FIG. 8) to withdraw the forward protuberance 164 below thefront of the clip guideway and to raise the rearward protuberance 166into the clip guideway. At the point in the operating sequenceillustrated in FIG. 8, the front clip 10 cannot be discharged from theinstrument because the top of the clip, namely the clip protuberance 21,is engaged by the upper jaw 112 and because the clip base flanges arestill retained in the clip guideway channel 122 by the flanges 124.

When the instrument handles are fully closed, the spacing between thejaws 111 and 112 is at a minimum as best illustrated in FIGS. 2C and 9.In this fully closed position, the front clip 10 has been latched closedabout the blood vessel 200. Although the forward protuberance 164 of theescapement member 160 has been retracted below the base of the frontclip, the front clip cannot be discharged from the instrument since itis still engaged by the jaws 112 and 111 which are squeezing the cliptogether. Further, the upper jaw 112 preferably has a receiving cavity208 as best illustrated in FIGS. 8 and 9 for preventing forward movementof the clip beyond the position illustrated in FIG. 9 until the jaws aresubsequently opened an amount sufficient to provide clearance betweenthe upper jaw 112 and the clip protuberance 21.

FIG. 10 illustrates in the jaws 111 and 112 being moved apart a distancesufficient to permit the latch closed front clip 10 to be dischargedfrom the instrument. Specifically, the jaws 111 and 112 are opened anamount sufficient to permit the clip protuberance 21 to clear the upperjaw 112. Further, the entire instrument is moved rearwardly a smallamount in the direction of the arrows 210 by the surgeon to permit theupper and lower jaws to completely clear the back of the clip 10 that isclosed about the blood vessel 200.

When the jaws 111 and 112 are opened an amount sufficient to permit thedischarge of the clip 10 from the instrument as illustrated in FIG. 10,the remaining clips in the row are urged forwardly by the pusher tape128 to positively eject the front clip beyond the ends of the guidewayflanges 124. As can be seen from FIG. 8, the front face 50 of the baseof the second clip is initially disposed behind the rearwardprotuberance 166 of the escapement member 160 by a distance X.Preferably, the distance X is equal to the length of the leg rearsection 41 (the rear section 41 being clearly illustrated in FIG. 1).Consequently, when the jaws 111 and 112 are opened sufficiently asillustrated in FIG. 10, the latched closed front clip is pushed forwardthe distance X by the next rearwardly adjacent clip until the base frontface 50 of that next rearwardly adjacent clip is engaged by the upwardlyprojecting rearward protuberance 166 of the escapement member 160.

In view of the above description, and with reference to FIGS. 2B, 2C, 9,and 10, it should be apparent that the camming surfaces 184 function tomaintain the rod 168 in the extreme rearward position during the lastportion of the closing movement of the jaws as well as during the firstportion of opening movement of the jaws. That is, the rod 168 is in theextreme rearward position just before the jaws are closed to the minimumspacing illustrated in FIG. 9 and also as the jaws are subsequentlyopened an amount sufficient to permit discharge of the latched closedclip. Thus, the escapement member 160 is maintained in the firstorientation during the last portion of the closing movement of thehandles as well as during the initial portion of the opening movement ofthe handles.

As the handles are opened still further, the jaws are necessarily movedaway from each other by a greater amount as illustrated in FIG. 11. Asthis occurs, the camming surfaces 184 permit the cylindrical camfollower 180 to be biased forwardly by the spring 176 (FIG. 2B) to movethe rod 168 forward and to thus pivot the escapement member 160 in theopposite direction so as to lower the rearward protuberance 166 andraise the forward protuberance 164. In the position illustrated in FIG.11, the rearward protuberance 166 is being lowered to the point where itis almost, but not quite, clear of the clip base engaging face 50.

FIG. 12 illustrates the jaws 111 and 112 having been opened more than inFIG. 11 but not yet to the fully opened position. In this position, therearward protuberance 166 has been retracted completely below the nextclip base face 50 to permit the next clip to advance toward the jawregion. However, since the jaws are not fully opened, the top of theclip impinges against the upper jaw 112 and further movement of the clipforwardly into the jaw region is prevented.

When the jaws 111 and 112 are finally fully opened, the clip is free tobe moved forward into the jaw region until the clip base face 50 isengaged by the raised forward protuberance 164 of the escapement member160. When the jaws are thus fully opened, the clip would assume the sameposition illustrated for the front clip in FIG. 7.

By comparing FIG. 11 with FIG. 7, it can be seen that each clip isadvanced forwardly a distance Y (FIG. 11) from the point of engagementwith the escapement rearward protuberance 166 to the point of engagementwith the escapement forward protuberance 164. This advancement occursduring the opening of the jaws after the front closed clip has beendischarged.

With reference to FIG. 10 and the novel escapement and jaw structuredescribed above, it is seen that each clip can be guided within thelower channel 122 beneath the flanges 124 without impeding the ejectionof the clip after it has been latched closed. This is because the baseflanges 52 (FIG. 1) extend only along the middle section of the clip legand not along the rear section of the clip leg. Thus, as soon as themiddle section of the clip has moved past the front end of the flanges124, the clip is no longer positively retained within the instrument.

Further, since the clip base 45 (FIG. 1) does not extend forwardlybeyond the middle section 42 of the clip leg, there is a recess belowthe front section 43 of the clip leg that accommodates the escapementmember rearward protuberance 166 for effecting precise control of theforward progress of the clip as described above.

From the foregoing, it will be observed that numerous variations andmodifications may be effected without departing from the true spirit andscope of the novel concept of the invention. It is to be understood thatno limitation with respect to the specific apparatus illustrated hereinis intended or should be inferred. It is, of course, intended to coverby the appended claims all such modifications as fall within the scopeof the claims.

What is claimed is:
 1. A ligating clip adapted to be applied to tissue,each said clip comprising:first and second legs joined at their proximalends by a resilient hinge to define the rear end of the clip andterminating at their distal ends at the front of the clip in latch meansfor holding the clip latched closed when the clip legs are squeezedtogether, each leg having a vessel clamping inner face in opposition toa vessel clamping inner face of the other leg; a base extending along aportion of said first leg, said base terminating short of the distal endof said first leg in a front face whereby an open recess is definedadjacent said base front face below said first leg; and flangesextending rearwardly along a portion of the length of said base fromsaid base front face and terminating short of said first leg proximalend, said flanges extending laterally outwardly beyond the sides of thefirst leg, the portion of said base that extends along said first legbetween said first leg proximal end and said flanges having a width notgreater than the width of said first leg.
 2. The clip in accordance withclaim 1 wherein the portion of said base that extends along said firstleg between said proximal end and said flanges has a generally rightrectangular prism configuration.
 3. The clip in accordance with claim 1wherein the portion of said base with said flanges has a generally rightrectangular prism configuration.
 4. In a ligating clip adapted to beapplied to tissue; each said clip comprising first and second legsjoined at their proximal ends by a resilient hinge to define the rearend of the clip and terminating at their distal ends at the front of theclip in latch means for holding the clip latched closed when the cliplegs are squeezed together, each leg having a vessel clamping inner facein opposition to a vessel clamping inner face of the other leg, theimprovement characterized in that:said clip first leg has a (1) rearsection extending forwardly from said hinge at said proximal end, (2) afront section extending rearwardly from the distal end of the first leg,and (3) a middle section connecting said front and rear sections; saidclip includes a base extending along said rear and middle sections ofsaid first leg, said base terminating in a front face below the junctureof said middle and front sections of said first leg whereby an openrecess is defined adjacent said base front face below said first legfront section; said clip has flanges on said base along the length ofsaid clip first leg middle section, said flanges extending laterallyoutwardly beyond the sides of the first leg; and the portion of saidbase along said first leg rear section has a width not greater than thewidth of said first leg.
 5. The clip in accordance with claim 4 furthercharacterized in that the portion of said base along said first leg rearsection has a generally right rectangular prism configuration.
 6. Theclip in accordance with claim 4 further characterized in that said firstleg terminates at the distal end thereof in a deflectable hook memberextending from the vessel clamping inner face of said first leg, saidhook member having an inner face spaced from and substantially parallelto the vessel clamping inner face of said first leg; and in that saidsecond leg terminates at the distal end thereof in a surface adapted todeflect said hook member and enter the space between the inner face ofsaid hook member and the vessel clamping inner face of said first legwhereby, when said first and second legs are pivoted closed about saidhinge, the distal end of said second leg deflects and engages the hookmember of said first leg to latch the clip closed.
 7. The clip inaccordance with claim 4 further characterized in that said second legincludes a boss.
 8. The clip in accordance with claim 4 furthercharacterized in that the portion of the base with said flanges alongsaid first leg middle section has a generally right rectangular prismconfiguration.
 9. A ligating clip adapted to be applied to tissue by aninstrument that has an escapement to regulate the discharge of said clipfrom the instrument, each said clip comprising:first and second legsjoined at their proximal ends by a resilient hinge to define the rearend of the clip and terminating at their distal ends at the front of theclip in latch means for holding the clip latched closed when the cliplegs are squeezed together, each leg having a vessel clamping inner facein opposition to a vessel clamping inner face of the other leg; a baseextending along a portion of said first leg, said base terminating shortof the distal end of said first leg in a front face whereby an openrecess is defined adjacent said base front face below said first leg topermit the positioning of said instrument escapement temporarily againstsaid base front face; and flanges extending rearwardly along a portionof the length of said base from said base front face and terminatingshort of said first leg proximal end, said flanges extending laterallyoutwardly beyond the sides of the first leg to function as guide meansfor engaging portions of said instrument, the portion of said base withsaid flanges having a generally right rectangular prism configuration,the portion of said base that extends along said first leg between saidfirst leg proximal end and said flanges having a generally rightrectangular prism configuration with a width not greater than the widthof said first leg to facilitate ejection of the latched closed clip fromsaid instrument when said escapement is withdrawn.
 10. In a ligatingclip adapted to be applied to tissue by an instrument for holding andguiding a plurality of said clips, said instrument having an escapementto regulate the discharge of said clips from the instrument; each saidclip comprising first and second legs joined at their proximal ends by aresilient hinge to define the rear end of the clip and terminating attheir distal ends at the front of the clip in latch means for holdingthe clip latched closed when the clip legs are squeezed together, eachleg having a vessel clamping inner face in opposition to a vesselclamping inner face of the other leg, the improvement characterized inthat:said clip first leg has a (1) rear section extending forwardly fromsaid hinge at said proximal end, (2) a front section extendingrearwardly from the distal end of the first leg, and (3) a middlesection connecting said front and rear sections; said clip includes abase extending along said rear and middle sections of said first leg,said base terminating in a front face below the juncture of said middleand front sections of said first leg whereby an open recess is definedadjacent said base front face below said first leg front section topermit the positioning of said instrument escapement temporarily againstsaid base front face; said clip has flanges on said base along thelength of said clip first leg middle section, said flanges extendinglaterally outwardly beyond the sides of the first leg to function asguide means for engaging portions of said instrument; the portion of thebase with said flanges along said first leg middle section has agenerally right rectangular prism configuration; and the portion of saidbase along said first leg rear section has a generally right rectangularprism configuration and has a width not greater than the width of saidfirst leg to facilitate ejection of the latched closed clip from saidinstrument when said escapement is withdrawn.
 11. The clip in accordancewith claim 10 further characterized in that said first leg terminates atthe distal end thereof in a deflectable hook member extending from thevessel clamping inner face of said first leg, said hook member having aninner face spaced from and substantially parallel to the vessel clampinginner face of said first leg; and in that said second leg terminates atthe distal end thereof in a surface adapted to deflect said hook memberand enter the space between the inner face of said hook member and thevessel clamping inner face of said first leg whereby, when said firstand second legs are pivoted closed about said hinge, the distal end ofsaid second leg deflects and engages the hook member of said first legto latch the clip closed.
 12. The clip in accordance with claim 10further characterized in that said second leg includes a boss adapted tobe engaged by a portion of said instrument.